The Liverpool Care Pathway is of little clinical benefit for dying patients,
according to the first randomised trial of the controversial scheme.

Patients placed on the LCP, which was designed to provide dignity for those dying with terminal illnesses, saw no "clinically meaningful" advantage compared with people receiving standard care, researchers found.

A trial on cancer patients in 16 Italian hospital wards found that there was no difference in survival times, and no significant improvement in care for those on the pathway.

The results show that any future scheme aimed at replacing the LCP in England should be "grounded in scientific evidence" and tested in trials before being implemented, researchers claimed.

The approach to care for terminal patients, developed at the Marie Curie Hospice Liverpool and the Royal Liverpool University Hospital in the late 1990s, was supposed to mean that doctors could stop treatment if it would result in a more comfortable death, or withdraw food and drink if patients declined it.

But ministers announced this summer that the LCP would be phased out after an independent review uncovered evidence of abuse, including patients being unnecessarily sedated and denied food and water.

Prof Irene Higginson, co-author of the study from King's College London, said: "Our findings demonstrate just how important it is for any initiative that replaces the LCP in England to be grounded in scientific evidence and tested in controlled trials before being rolled out across the board.

"We must face this challenge head-on and ensure scientific evidence forms the foundations for any new initiative if end-of-life care is to be genuinely improved for patients and their families in England."

Prof Higginson and Italian colleagues randomly assigned staff at 16 general medicine hospital wards in Italy either to be trained in and implement the LCP approach, or to continue with standard health care.

They studied health records on 308 cancer patients who died during the following six months, as well as interviewing family members to assess the quality of their end-of-life care on a scale of one to 100.

LCP wards scored 70.5 and control wards scored 63 out of 100 – a difference too small to be judged statistically significant, researchers reported in The Lancet journal.

In two areas of care, respect, dignity and kindness, and control of breathlessness, there was some improvement in the LCP wards but there was no improvement in survival time.

Writing in a linked comment article Prof David Currow of Flinders University in Adelaide and Dr Amy Abernethy of Duke Clinical Research Institute in the USA said: “Across health care there is a need to improve care for people who are dying, which has led to widespread uptake of the LCP before adequate assessment.

"The results of the only adequately powered study of LCP so far have not shown clinically meaningful differences for patients — the ultimate measure of useful health policy."